April 14, 2020

Coronavirus Updates and Resources

The novel Coronavirus has led to outbreaks of respiratory illness in the US. The number of reported cases increases daily. Providers of all types care for some of the most vulnerable Texans, and it is important to stay up to date with all guidance and recommendations from HHSC, DSHS, and the CDC. Below are key resources for providers.

Personal Protective Equipment Solutions

The World Health Organization has warned of a potential shortage of Personal Protective Equipment including medical masks, hand sanitizer, protective eyewear, gowns and gloves. In the event PPE shortages, use the following as last resort emergency back-ups. These could offer temporary alternative solutions to protect the health of your staff and people receiving services.

Providers should first attempt to obtain PPE through their normal supply chain or through other typically available resources. These options include:

  • Contacting any sister facilities for coordination
  • Reaching out to local partners or stakeholders
  • Looking at any possible reallocations within the Public Health Region, Healthcare Coalition, Regional Advisory Council regions, or other medical supply agencies

Providers who can’t get PPE should follow national guidelines for optimizing their current supply or identify the next best option to care for people receiving services from the provider while protecting staff. If providers are unable to obtain PPE for reasons outside their control, HHSC surveyors will not cite them.

1. Recommendations for Optimizing PPE

For the most current guidance on the use of and how to conserve PPE, access resources from DSHS and CDC.

Hospitals and health care professionals who cannot obtain any PPE from their vendor(s) and have exhausted all alternatives, should send their official requests to their local office of emergency management via the State of Texas Assistance Request process. This is not a guarantee of receiving PPE. Supplies of PPE may be insufficient to meet demand.

Requesting PPE Through Local Emergency Management

STAR is a system operated by the Texas Department of Emergency Management. It allows local emergency coordinators to request equipment and supplies. By working through your local emergency management officials, you can ask them to initiate a STAR request.

Requesting PPE Through a Regional Advisory Council

Each of the 22 RACs in Texas is tasked with developing, implementing, and monitoring a regional emergency medical service trauma system plan. Providers also can contact their RAC to request PPE.

One of the RACs, the Southeast Texas Regional Advisory Council has an online request for PPE. SETRAC serves southeast Texas. If you are served by SETRAC, follow this process to request PPE:

  • Visit the SETRAC website.
  • Navigate to the COVID-19 page and forms section.
  • Complete the form. Include details such as the type of item and number of each item requested, as well as the point of contact for the order.

RAC contacts
Map of RACs
Map of Trauma Service Areas with RAC Names

2. CDC Recommendations for Use of Cloth Face Coverings

The CDC is now recommending cloth face coverings in public settings, when social distancing is difficult to maintain, such as grocery stores and pharmacies. However, maintaining the 6-foot social distancing is still critical to slowing the spread of the virus. More information on cloth face coverings is available on the CDC website.

The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

When medically approved facemasks are not available, health care personnel might need to use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

These resources have not been independently endorsed or verified. This does not constitute guidance or a requirement from HHSC.

3. Hand Soap as Alternative to Hand Sanitizer

In settings where there is a shortage of alcohol-based hand sanitizer, use hand soap with pump hand soaps or bar soaps as a last resort.

4. Isolation Gowns

Extended Use of Isolation Gowns

Consideration can be made to extend the use of disposable or cloth isolation gowns. This means the same HCP wears the same gown when interacting with more than one patient known to be infected with the same infectious disease when these patients are housed in the same location (i.e., COVID-19 patients residing in an isolation cohort). This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridioides difficile) among patients. If the gown becomes visibly soiled, remove and discard per usual practices.

Re-use of Cloth Isolation Gowns

Disposable gowns are not typically amenable to being doffed and re-used because the ties and fasteners typically break during doffing. Cloth isolation gowns could potentially be untied and retied and could be considered for re-use without laundering in between.

Staffing for Long Term Care Facilities

Certain requirements for Long-Term Care facilities have been suspended in response to the state of disaster declared by the Governor, including several related to licensure or certification of certain healthcare professionals. In addition, the suspension will allow NATCEP and Medication Aide raining programs to complete the classroom portion online and clinical/skills training in a laboratory setting. More information about the specific requirements that have been suspended can be found in Provider Letter 20-21, issued March 20.

Requirement to Report COVID-19 to HHSC

Provider must report every confirmed case of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident.

A confirmed case is considered a critical incident. Providers (other than HCS and TxHmL providers) must notify HHSC through TULIP or by calling Complaint and Incident Intake (CII) at 1-800-458-9858. HCS and TxHmL providers must notify HHSC at: waiversurvey.certification@hhsc.state.tx.us.

Once an initial report has been submitted, providers do not need to submit new reports for each additional case of COVID-19. Instead, the provider should amend/update the original report referencing the intake number provided by CII.

General Resources

The following are reliable websites and resources to promote safety for your staff and the people you serve.

DSHS

HHSC

CDC

EPA

New Resources for Long-Term Care Facilities

New HHSC Resources for Home and Community-Based Services

Quality in Long-Term Care Conference Moving Online Due to COVID-19

Due to the current COVID-19 pandemic, HHS has made the decision to move forward with an online Quality in Long-Term Care conference, rather than the event previously scheduled for the Hyatt Regency Lost Pines Resort. We are committed to providing the same quality of information to support providers and community caregivers using a digital platform. More information will be available soon.

Free Music and Memory Services for Current and Previously Certified Facilities

Music and Memory is offering three-months of free access to services and supports for all current and previously certified Music and Memory Facilities through July 8th, 2020. Current and previously certified facilities may contact: carequestions@musicandmemory.org.

For more information about Music & Memory, visit:

Online Training Courses Now Available in the HHS Learning Portal

Four online training opportunities are now available through the HHS Learning Portal:

  • Feeding Assistant Training - This curriculum was developed for use by participants in a feeding assistant training class and includes both instructor-led and online components. The goal is for residents to receive more assistance with eating and drinking to help reduce the incidence of unplanned weight loss and dehydration. This course must be taught by a licensed health professional (physician; physician assistant; nurse practitioner; physical, speech, or occupational therapist; pharmacist; physical or occupational therapy assistant; registered professional nurse; licensed vocational nurse; licensed dietitian; or licensed social worker) or registered dietician, and participants must demonstrate safe feeding techniques by performing two feedings in the Module 9 Practicum under the observation of a licensed nurse.
  • Advanced CNA Academy – This comprehensive, five-module online course will provide nursing facility staff with thorough and sustainable education, information, and resources related to the Advanced Certified Nursing Assistant (CNA). Individual modules examine the role of the CNA in providing quality care, nursing facility rules and regulations, quality care for geriatric residents and residents with intellectual and/or developmental disabilities or mental illnesses, the role of CNAs in supporting resident assessments, and the safety and well-being of residents. Both a final exam and a training survey are required as part of the course. This online course has been approved for 6.0 hours of continuing education credit by HHSC for CNAs. HHSC is an approved provider of continuing education credits for CNAs as governed by 26 TAC Chapter 556, Section 556.9(3)(C).
  • PASRR in the Nursing Facility – A new online Preadmission Screening and Resident Review (PASRR) course for nursing facility (NF) staff is now available. This nine-module, comprehensive online course will provide thorough and sustainable education, information, and resources that are needed to successfully complete all NF responsibilities related to the PASRR process. In addition, this training will detail the complexities of caring for residents with intellectual or developmental disabilities, mental illness, or both. This course has been approved for 7.0 hours of continuing education credit by HHSC for the following professions: Licensed Social Worker, Licensed Professional Counselor, Licensed Marriage and Family Therapist, Licensed Nursing Facility Administrators, Nursing Facility Activity Directors, Qualified Intellectual Disability Professionals, Certified Nurse Aides, and Licensed Psychology Professionals.
  • Meaningful Engagement to Enhance Quality of Life – Designed for nursing facility activity directors, licensed nurses, certified nurse aides, and ancillary staff, this online training explains evidence-based best practices to help staff develop meaningful and relevant person-centered activity programs and implement individualized activities that reflect each resident’s preferences, customary habits, and lifestyle. This online course has been approved for 4.0 hours of continuing education credit by HHSC for the following professions: CNAs and Nursing Facility Activity Directors (NF-AD).

To take these courses, visit the HHS Learning Portal and create a secure user account. After creating your account, navigate the portal to find the course, or use the course links provided above.

Email questions to QMP@hhsc.state.tx.us.

Quality Assurance Performance Improvement and Resident Safety – Roadmap to Quality

Although the regional conferences have ended, the HHS Quality Monitoring Program continues to offer support for NFs as they work on improving their QAPI programs. NFs can also request reviews of their QAPI plans. Contact Sheila Shepherd, MSN, RN, for individual consultation about your facility’s QAPI program:

  • Email
  • Phone (512) 438-4184
  • Text (850) 867-8669.

The monthly QMP QAPI newsletter is now available on the QAPI Training homepage.

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